Epidemiological studies have revealed that stressful changes in social environment increase the risk of cardiovascular mortality. In this study, the influence of major negative and positive life changes on serum cholesterol was examined in middle-aged men to determine a possible biochemical link between life changes and cardiovascular mortality. The results showed no influence of negative life changes on serum cholesterols. However, positive life changes significantly predicted a reduction in total and LDL (low-density lipoprotein) cholesterol levels after adjustment for the baseline cardiovascular health status, baseline cholesterol level, diet, body mass index, waist-to-hip ratio and cardiorespiratory fitness. The odds ratio for lowering LDL cholesterol was 5·2 in the men reporting positive events compared with those reporting none. The findings suggest a predictive value of positive life changes for atherogenic lipid profile in middle-aged men.

A characteristic of African pre-transitional fertility regimes is large ideal family size. This has been used to support claims of cultural entrenchment of high fertility. Yet in Kenya fertility rates have fallen. In this paper this fall is explored in relation to trends in fertility norms and attitudes using four sequential cross-sectional surveys spanning the fertility transition in Kenya (1978, 1984, 1989 and 1998). The most rapid fall in the reported ideal family size occurred between 1984 and 1989, whilst the most rapid fall in the total fertility rate occurred 5 to 10 years later, between 1989 and 1998. Thus these data, spanning the fertility transition in Kenya, support the traditional demographic model that demand for fertility limitation drives fertility decline. These data also suggest that the decline in fertility norms over time was partly a period effect, as the reported ideal family size was seen to fall simultaneously in all age cohorts, and partly a cohort effect, as older age cohorts reporting higher ideal family sizes were replaced by younger cohorts reporting lower ideal family sizes. These data also suggest that a new fertility norm of four children may have developed by 1989 and continued until 1998. This is consistent with, and perhaps could have been used to predict, the stall in the Kenyan fertility decline after 1998.

At the end of the fourth week of the Spring term 1982, 730 female undergraduates at Aberdeen University and 744 female under-graduates at Oxford University were sent a questionnaire enquiring about their sexual behaviour and contraceptive practice. Of the 978 unmarried women who replied, 507 (52%) had experienced sexual intercourse. No contraception had been used by 31% of the women on the first occasion that they had had intercourse; during the 4-week period preceding receipt of the questionnaire 14% of sexually active women had had intercourse on one or more occasions without a contraceptive. Twenty-nine women had been pregnant in the past; two women were known to be pregnant at the time of the survey and twelve women thought that they might be. These findings are discussed and some recommendations are put forward.

A procedure for assessing birth spacing goals, an important component of fertility preferences, is proposed and applied to 1993 Costa Rican data. Based on a reverse or backward survival analysis, preferred birth intervals are estimated to range between 3·5 and 4·5 years (1·5 years for the interval union to first birth). These intervals are 2 or 3 years shorter than crude estimates from data on open or last closed intervals, which are upwardly biased by selection and left censoring effects. To achieve these spacing preferences, a cohort must spend about two-thirds of the time using contraception (one-third in the interval union to first birth). An inverse association between desired family size and desired birth interval is evident only in parity-specific analyses.

Adult mortality in Burundi during the 1970s and 1980s is estimated using data from the 1987 Demographic and Health Survey (DHS). Estimates from traditional indirect methods are compared with those from the inter-survey method using data on the number of years since the respondent's parent died. Life expectancy at birth was estimated as 48.55 years for males and 51·23 years for females.

Vitamin D is an important nutrient for bone health, and vitamin D deficiency increases the risk of various diseases. Gilgit Baltistan, the northern-most area of Pakistan, has a high prevalence of vitamin D deficiency, despite many nutritional and food safety programmes. The present study aimed to find how knowledge, attitudes and practices associated with vitamin D related to the prevalence of vitamin D deficiency among people residing in different areas of Gilgit Baltistan. The cross-sectional study was descriptive and used data from a survey carried out between February 2019 and December 2020 on individuals of both sexes aged 10 years or over in Gilgit Baltistan. Of the 575 survey participants, 306 (53.2%) had experienced signs and symptoms of vitamin D deficiency, i.e. tiredness, fatigue and bone weakness. Approximately 64.8% had some general knowledge of vitamin D and its relation to health. Participants aged 19–25 years had the highest scores on knowledge of vitamin D. Only 22.7% of interviewees had ever taken any supplements and only 25.6% often exposed themselves to sunlight. Females’ mean knowledge score (28.7; SD 7.02) was higher than that of males (24; SD 9.01). A lack of consistency was observed between attitude towards daylight exposure and knowledge of vitamin D. There was a large correlation between knowledge and attitude (p = 0.001), while a non-significant association was demonstrated between knowledge and practices (p = 0.1). Better knowledge, attitude and practices by people living in cities or more-developed regions indicates that education can be an effective way to provide awareness regarding micronutrient deficiencies. More emphasis is needed on enhancing knowledge, awareness and practices associated with vitamin D deficiency in rural areas of Pakistan. It is strongly recommended that an awareness campaign on micronutrients is launched in both rural and urban areas of Pakistan, concentrating on poor socioeconomic settings.

Globally, diarrhoea is the third leading cause of death for under five-children. Women’s empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women’s empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57–0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65–0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women’s age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women’s empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women’s empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women’s education and decision-making power and enhancing awareness of women’s human and democratic rights.

The Board of the Marie Stopes Memorial Foundation organized in 1971 the first of a series of Marie Stopes Memorial Lectures to celebrate the 50th anniversary of the opening of her first clinic in Holloway in 1921 (Taylor, 1971). A second lecture was arranged in 1972 (Mitchell, 1973). For 1973, the Board decided to vary the pattern and asked us to write an account of the clinic in the 1920s and 1930s, a neglected subject compared with the voluminous studies of Marie Stopes herself. In accepting this invitation, we realized that there was some factual material available, but that for the human touch we should have to rely largely on those still available who knew the clinic in its early days. It seemed therefore that the interview technique would be best suited to bringing out the highlights. In this we have been fortunate in having the most helpful co-operation.

The family registration records from a village population in a small island of Japan are used to assess the effect of demographic differentiation within a population on genetic measures. When the couples studied are classified by birth cohorts and origins, wives of the couples where one spouse came from elsewhere were older at marriage and had a shorter duration of marriage or registration than wives where both spouses were natives of the village. The mean number of offspring is statistically smaller in the former except for the latest cohort, due mainly to out-migration during the reproductive ages which also resulted in low rates of marriage among the offspring within the village. This leads to a small effective population size and an increased likelihood of genetic drift in the overall population.

Using individual birth history data from the Sudan Fertility Survey, 1979, parity-related differences in fertility are demonstrated, as well as differences between socioeconomic groups. Rural women, women with no education and those married to uneducated husbands show rapid parity progression and its cumulative effects on fertility which are consistent over all birth intervals. Urban women, women with some education and those married to educated husbands, however, go rapidly through their second and third birth intervals and then more slowly at higher parities. A limitation of the study was the inability to control fully for the effects of breast-feeding and contraception.

There is evidence for a reduction in high parity births,' starting in the 1970s.

The aim of this cross-sectional study was to investigate beliefs, attitudes and reproductive behaviours in relation to consanguinity in a population living in the backlands of north-eastern Brazil. Data were collected by face-to-face interview from 147 high school students aged 13–20 years and from 532 elderly individuals aged 60 years and over from Brejo dos Santos in the state of Paraíba in 2017. The frequency of consanguineous marriage was found to have increased over the generations, being 15.9% in the parents of the elderly participants, 17.1% in the elderly participants themselves and 20.5% in their descendants. Although 258 (50.9%) of the elderly interviewees opposed consanguineous union, 341 (65.3%) would approve of the marriage of their children with relatives. Both the young (n=108 or 78.3%) and elderly (n=398 or 80.4%) interviewees believed that consanguineous marriages were no more durable than non-consanguineous marriages (p=0.578). Additionally, 408 (82.4%) of the elderly individuals and 108 (80.6%) of the students recognized that spouses in consanguineous unions experience conflicts, just like other couples do (p=0.625). In both groups, the majority of the participants did not believe that consanguinity increased the risk of having children with disabilities. The regression of the two continuous variables ‘age’ and ‘positive attitudes score’ showed a significant correlation, suggesting that younger individuals are more susceptible to the influence of cultural factors contributing to consanguinity, such as the opinions of their parents and grandparents. The belief that consanguineous unions are more durable showed a significant difference between elderly individuals in consanguineous and non-consanguineous unions (p=0.001); the former were 2.42 more likely to believe that marriages between relatives contributes to marriage durability.

For most people in the world the private sector has long been the principal source of contraceptive supplies. However, few attempts have been made to examine and quantify commercial contraceptive sales. This paper outlines the findings of a contraceptive market survey of Nigeria, Ghana, Uganda and Kenya. The sales statistics and marketing practices for various contraceptive products were obtained by interview from the principal distributors in each country. The sales figures were subsequently cross-checked with manufacturers' agents, and in some cases the overseas manufacturers. The clinic attendance records of local family planning organizations were also reviewed. The findings show that the commercial distribution of contraceptives exceeds public sector activities in Nigeria, Ghana and Uganda, but not in Kenya.

The risk of developing a major non-communicable disease is critically affected by lifestyle choices. This study examined the consequences of factors that might predict a change in the self-rated health of older adults and aimed to assess their monetary costs. In particular, two predisposing risk factor moderators were studied: high blood pressure and high cholesterol. The effects of these on two serious adverse cardiovascular events – heart attack and stroke – were estimated. Using data from the Survey of Health, Aging and Retirement in Europe (SHARE) carried out in 2014, a two-stage procedure was applied as well as pairwise comparison. The results revealed the significant role of socioeconomic status in health outcomes. Behavioural risk factors were found to be significant predictors for heart attack and stroke. The findings support the claim that variables such as age, wealth and behavioural risk factors are additional predictors of a change in these two diseases. The monetary consequences can reach up to 12.8 thousand Euros for older adults per unit of predisposing risk factor. Since national health budgets are limited, health policies might be prioritized.

Vaccines for COVID-19 began to be available in Africa from mid-2021. This paper reports on local reactions to the possibility of vaccination in one West African country, Sierra Leone. We show that the history of institutionalisation of vaccine is highly relevant to understanding these reactions. Given lack of testing for the disease, medical authorities could not be sure whether there was a hidden epidemic. In addition, many people associate vaccination with care of children under 5 years, and not adults, and an emphasis on vaccinating the old at first seemed strange and worrying. This paper examines evidence from ethnographic studies in two rural areas selected for varying exposure to Ebola Virus Disease (EVD), supplemented by some interviews in two provincial urban centres, Bo and Kenema. We describe local ideas about vaccination (maklet) and body marking with leaf medicine (tεwi). We asked about attitudes to the idea of COVID-19 vaccination both before and after vaccines were available. A number of reasons were given for scepticism and hesitation. These included lack of experience with vaccines for adults and lack of experience of COVID-19 as a severe disease. Medical evidence suggests the vaccination protects against serious illness, but local people had their own views about control of infection, based both recent experience (notably EVD) and the history and institutionalisation of vaccination and public health measures in Sierra Leone more broadly.

Uganda has received praise for its success in dealing with the COVID-19 pandemic. This opinion piece uses publically available data from Johns Hopkins University to suggest that it is far from clear whether the Public Health and Social Measures (PHSM) introduced in Uganda influenced the course of the first outbreak. In addition, the analysis of data from the second and third waves in Uganda suggest that government action had little or no effect on these outbreaks. The dominant narrative of successful PHSM, therefore, needs to be reconsidered, and alternative explanations for the low rates of COVID-19-related mortality in the country need to be further understood.

This paper examines the degree to which childlessness is influenced by levels of modernization among the governorates of the Arab Republic of Egypt. In 1976, the higher the levels of modernization, the lower the rates of childlessness among women aged 30 and over, and the higher the rates of childlessness among women aged 20–30. The implications of these results for fertility and development are discussed.

The aim of this study was to determine whether the living conditions of school children affects their body structure and muscular strength. Data were taken from 400 girls and 341 boys aged 7–15 years attending nine primary schools in Warsaw in 1997. A questionnaire was completed, anthropological measurements made and two muscular strength tests conducted. The questionnaire asked questions on the children’s level of education, their parents’ professions and monthly incomes, the number of persons in the family and the number of rooms in the family’s apartment/home. Body height, body weight, chest and arm circumferences, grip strength and vertical jump height were measured and used to calculate body mass index, Marty’s Index and the Sargent Vertical Jump Index. Statistical tests included Student’s t-test, Principal Component Analysis (PCA) and multiple regression analysis. Body height, chest circumference, Sargent Vertical Jump Index and grip strength were significantly greater in the boys than the girls. Two factors, namely ‘socioeconomic status’ (F1) and ‘family size’ (F2), describing living conditions, were isolated after PCA. Boys from bigger families (F2) were shorter, with lower weights and BMIs, smaller chest and arm circumferences and greater grip strengths than those from smaller families, whereas girls from families of lower socioeconomic status (F1) weighed less and had greater BMIs and arm circumferences than those from higher socioeconomic status families. The results suggest that boys seem to be more ‘ecosensitive’ than girls.

The objective of the present analysis was to study the associations between body weight psychosocial correlates and body mass index (BMI) among four groups of adults in the Quebec population. Data were taken from the Social Lifestyles and Health 1998 Survey performed by the Institut de la Statistique du Québec (ISQ). The suggested guidelines of the ISQ were used to estimate the population's proportions and for statistical analysis. The groups studied were 25- to 44- and the 45- to 64-year-old men and women. In all groups, currently trying to lose weight increased the odds of reporting an excess weight. Better perceived eating habits was associated with lower BMI in most groups except in the 25- to 44-year-old women, where the trend was not significant. Higher number of physical activities related to transport and cigarette smoking were associated with lower BMI in both men groups. In both women groups, more frequent consumption of alcoholic beverages decreased significantly the odds of reporting excess body weight. A university degree was associated with a lower BMI only in the 25- to 44-year-old men. Regular practise of leisure time physical activity was associated with a lower BMI only in 45- to 64-year-old women. Opposite associations were observed between perceived health and BMI. In the 45- to 64-year-old men, better perceived health increased the odds of reporting an excess weight. Conversely, the odds of reporting excess weight decreased with better health in 25- to 44-year-old women. Many correlates differ between age group and sex. The identification of these factors illustrates the need to adapt obesity-related programmes toward specific sub-groups within the general population.

The findings relating to marriage and fertility of the National Survey of 1960 Graduates show that highly-educated people are on the whole no exception to the generally observed principle of social and educational endogamy. Those from working-class homes, however, marry overwhelmingly into the middle class, so that marriage here constitutes a means of consolidating newly-won status. Respondents on the whole tended to delay marriage and family building while still engaged in full-time study, but more graduates are ultimately marrying and are doing so at younger ages than ever before. There are also certain consistent differences between the sexes, which indicate that women graduates are much more susceptible than men to the delaying influences on marriage and family building of the continued exposure to higher education.

The 1981 Bangladesh Contraceptive Prevalence Survey found that 55% of ever-married women had some knowledge of traditional methods of contraception and the overall level of ever use was 23%. There was a positive relationship between use and socioeconomic variables. Current use of traditional methods at 7·7% was only slightly below the figure for modern methods (10·9%). It is suggested that traditional methods still have an important role in family planning and that this should not be disregarded.